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Dear Readers,
Glaucoma is a disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye.

Glaucoma has been nicknamed the "silent thief of sight" because there are usually no symptoms or pain associated with the onset of glaucoma and the loss of vision normally occurs gradually over a long period of time and is often recognized when the disease is quite advanced. Once lost, this damaged vision cannot be recovered. Worldwide, it is the second leading cause of blindness. If the condition is detected early it is possible to slow the progression with medical and surgical means. According to the latest assessment, it is estimated that 66.8 million people would have had primary glaucoma by the year 2000, with 6.7 million suffering from bilateral blindness. So screening programme will help in early detection and treatment. This site news uses a general approach to the understanding of screening programs. However, specific comments and a review of screening studies are limited to the more common, open-angle forms.

This issue Introduces you to the Magnitude of glaucoma, talks about Glaucoma Screening, and Risk Factors, which will enable you to understand the problemsrelated to Glaucoma.

The organization, which we are featuring, is a Glaucoma Research Foundation and the featured personality is Dr.Hans Goldmann, Chairman of the Department of Ophthalmology in Berne in 1935. We also feature about the History of glaucoma.We wish you an experience of learning that is very practical. Your feedback will help us to improve. Please send in your feedback at eyesite@aravind.org. We wish you happy reading and do look forward to receiving your feedback.

Regards,
Library Team
The Issue Features...
GLAUCOMA SCREENING
Vol. 6 No.7 July 2010
•   Introduction
•   Magnitude of Glaucoma
•   Glaucoma screening
•   Benefits of Glaucoma    Screening
•   Risk Factors
•   Glaucoma Awareness
•   Resources
•   History of Ophthalmology
•   Featured Personality
•   Featured Organisation
•   Talk to Us
•   Past Issues

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  • INTRODUCTION

  • This article briefs what is glaucoma, types, symptoms, diagnosis and treatment of glaucoma.



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  • PREVALENCE OF GLAUCOMA IN INDIA AND THE WORLD

  • This review article focuses on the prevalence of glaucoma in Europe, North America, Latin America, Africa, and India and also points out reasons for regional variations in glaucoma prevalence. It provides detailed information about prevalence of Primary open angle glaucoma, and risk factors of angle closure disease, Exfoliation glaucoma, secondary glaucoma etc in India. It concluds with the present status of Glaucoma blindness in India and how public education, counseling and mass media can create glaucoma awareness in rural community to solve the problem.

  • GLAUCOMA IN INDIA: ESTIMATED BURDEN OF DISEASE.

  • Over the last decade the prevalence of glaucoma has been reported by the Vellore Eye Survey, Andhra Pradesh Eye Disease Study, Aravind Comprehensive Eye Survey, Chennai Glaucoma Study, and West Bengal Glaucoma Study. There have been some differences largely because of methodological variations. We use the reported age and gender stratified prevalence estimates from these studies and the Indian population census estimates to calculate the number of persons with glaucoma or at risk of the disease in the country. On the basis of the available data, we estimate that there are approximately 11.2 million persons aged 40 years and older with glaucoma in India. Primary open angle glaucoma is estimated to affect 6.48 million persons. The estimated number with primary angle-closure glaucoma is 2.54 million. Those with any form of primary angle-closure disease could comprise 27.6 million persons. Most of those with disease are undetected and there exist major challenges in detecting and treating those with disease. In the light of the existing manpower and resource constraints, we evaluate options for improving case detection rates in the country.

  • "MAGNITUDE OF GLAUCOMA BLINDNESS IN DEVELOPING COUNTRIES"

  • This article provides information about overview of glaucoma blindness in developing countries such as India, China, Sub-Saharan Africa and Latin America. It provides glaucoma blindness data from the available sources, lists out the difficulties to measure glaucoma blindness and Indicators to measure burden of glaucoma blindness in India. Author points out the causes of lack of glaucoma awareness and how to overcome the problem in developing countries.

  • GLAUCOMA - THE PRESENT SCENARIO

  • This article focuses on understanding of glaucoma, new development in diagnosis, treatment, medical therapy, newer drugs, latest technique of laser photocoagulation , current surgical techniquesin glaucoma and the latest advancement of glaucoma treatment etc.

  • NUMBER OF PEOPLE WITH GLAUCOMA WORLDWIDE

  • This article focuses on estimation of the prevalence of glaucoma among people worldwide. The prevalence was reviewed with available published data on glaucoma to determine the relation of open angle and angle closure glaucoma with age in people of European, African, and Asian origin. A comparison was made with estimated world population data for the year 2000. and it points out there is a need of awareness of the disease among the glaucoma patients in the developed and developing countries because Glaucoma is the second leading cause of vision loss in the world. So it concludes that improved methods of screening and therapy for glaucoma are urgently needed.

  • THE NUMBER OF PEOPLE WITH GLAUCOMA WORLDWIDE IN 2010 AND 2020

  • This article estimates the number of people with open angle (OAG) and angle closure glaucoma (ACG) in 2010 and 2020. This reveals that there will be 60.5 million people with OAG and ACG in 2010, increasing to 79.6 million by 2020.



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  • Glaucoma Screening

  • This article focuses on different types of Glaucoma screening, purpose of screening, how and who to examine and medical management. In this article statistical conclusion specifies that estimated number of glaucoma patient is higher and the rate of occurrence is lower. This article concludes that all patients above age of 40 attending camps and hospitals should be screened. ophthalmologist should form a glaucoma committee, they have to study and decide the normal intraocular pressure of the population around them taking into consideration the age, sex, social habits etc., they should screen all the population of the area with the help of social service organization and after deciding critical intraocular pressure, it is to be formulated by a standard method of treatment.

  • RURAL GLAUCOMA SCREENING

  • This study focuses rural Glaucoma Screening program in New York. It suggests how in a glaucoma detection, the official public health agency, the local ophthalmologists, the county medical societies, and the local Lions Clubs are involved to solving this community health problem.

  • GLAUCOMA SCREENING

  • This article describes different types of glaucoma screening that can be conducted - by testing a large number of unselected persons from a community, testing an entire community or a selected cross section of that community (or) special surveys of a small, but not necessarily representative, segment of the population chosen for more extensive testing or "longitudinal studies. The purpose of mass screening of this type is twofold: (1) To increase public awareness of glaucoma and of the need for periodic examinations by an ophthalmologist, and (2) To detect more cases of glaucoma than would be otherwise possible. This article specifies that adequate epidemiological information on the prevalence of glaucoma cannot be obtained by the usual mass glaucoma-screening program, so there is a need to conduct a survey or longitudinal studies to detect the glaucoma patient.

  • GLAUCOMA SCREENING and DIAGNOSIS

  • This article emphasizes the role of screening in the diagnosis of glaucoma. This article stresses that it is very important to have regular eye examinations, particularly as you age, or if you have any of the risk factors associated with glaucoma.

  • SCREENING FOR GLAUCOMA WAITING UNTIL OUR VISION CLEARS.

  • This article distinguishes screening from case finding and explains to what extent screening for glaucoma leads to reduction in pseudo-disease. It comprehends that people with signs or symptoms need to be evaluated. It concludes that screening for increased IOP and for early glaucoma leads to treatment that improves vision in a way that our patients will notice and appreciate. But initiating widespread screening at present is premature. Treating pseudo disease helps no one.

  • GLAUCOMA SCREENING IN PRIMARY CARE: THE ROLE OF NONCONTACT TONOMETRY

  • This article describes the use of noncontact tonometer as an important tool in glaucoma screening.

  • SCREENING FOR GLAUCOMA: RECOMMENDATION STATEMENT

  • This article describes the recommendation made by the U.S preventive service task force for or against screening adults for glaucoma.

  • UNDERSTANDING THE GENETICS OF PRIMARY GLAUCOMAS IN THE INDIAN POPULATION

  • This article gives an idea of glaucoma genetics in India and significance of genetics screening in glaucoma.

  • TELEMEDICINE SCREENING OF GLAUCOMA

  • This pilot study explores the use of stereo digital images taken at a primary care center for telemedicine review by an off-site specialist as a means of screening of glaucoma.

  • FREE GLAUCOMA SCREENING RESOURCES

  • This web page tells about different organizations providing free glaucoma screening.

  • SCREENING FOR PREVENTION OF OPTIC NERVE DAMAGE DUE TO CHRONIC OPEN ANGLE GLAUCOMA (REVIEW)

  • This review article describes screening for prevention of optic nerve damage due to chronic open angle glaucoma.

  • SCREENING TESTS FOR DETECTING OPEN-ANGLE GLAUCOMA: SYSTEMATIC REVIEW AND META-ANALYSIS

  • This article assesses the comparative accuracy of potential screening tests for open angle glaucoma . No test or group of tests was clearly superior for glaucoma screening. Further research is needed to evaluate the comparative accuracy of the most promising tests.(GAT, FDT, SAP and HRT) .

  • HOW ARE GLAUCOMA PATIENTS IDENTIFIED?

  • This article is to determine the events that lead to the diagnosis of glaucoma and administers a questionnaire to 308 consecutive patients. After the diagnosis the results depict that the detection of glaucoma is strongly associated with IOP measurement. Glaucoma is most frequently diagnosed at routine visits to eye care specialists at which patients either have no symptoms or have symptoms unrelated to glaucoma.

  • THE RESULTS OF SCREENING FREQUENCY DOUBLING TECHNOLOGY PERIMETRY IN DIFFERENT LOCATIONS OF THE COMMUNITY.

  • This article focuses on the results of FDT testing conducted by Vision Screening Outreach Project in community sites surrounding Portland, Oregon. It determines the effect of screening location on the frequency of abnormal test results with Frequency Doubling Technology (FDT) perimetry. It suggests that an investigator should repeat an initially abnormal FDT result when screening with FDT. Age and the location of testing influence the probability of a screening failure. Screening in senior centers is most likely to result in screening failure. However, only a randomized controlled trial can determine the true benefit of FDT screening in these locations.

  • IDENTIFICATION OF GLAUCOMA-RELATED VISUAL FIELD ABNORMALITY WITH THE SCREENING PROTOCOL OF FREQUENCY DOUBLING TECHNOLOGY.

  • This article evaluates the predictive power of frequency doubling technology to distinguish glaucoma suspects from persons with glaucoma visual field loss.

  • CURRENT AND FUTURE APPROACHES TO GLAUCOMA SCREENING.

  • This article discusses the various approaches towards the screening of glaucoma and it also defines glaucoma in such a criteria that would be agreed on by many ophthalmologists. This article gives information regarding various parameters to screen or define the glaucoma like tonometry, optic disc measurement, nerve fiber layer observation, perimetry etc.,

  • COMMUNITY SCREENING FOR EYE DISEASE BY LAYPERSONS: THE HOFFBERGER PROGRAM.

  • This article describes the results of a community-based eye screening program in Baltimore. Through this study the main outcome measures were the rate of appointment keeping and the eye diseases identified. Telephone interviews were used to assess reasons for missing appointments and satisfaction with visits. This article concludes that after community screening for eye disease, efforts to provide definitive ophthalmic examination were only modestly effective. Failure of screenees to come for examination and loss to follow up were identified as serious problems.

  • GLAUCOMA SCREENING: CURRENT TRENDS, ECONOMIC ISSUES, TECHNOLOGY, AND CHALLENGES

  • This article is about current trends of glaucoma screening. Glaucoma awareness needs to be increased through better education, and compliance with follow-up care needs to be improved to decrease the economic and social costs from glaucoma. In addition, screening models need to be developed that will be effective in developing countries where the risk of blindness from glaucoma is highest.



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  • SUSTAINED GLAUCOMA SCREENING PROGRAM

  • It also demonstrates how an official agency (health department) and a voluntary organization (Lions Club) can combine their efforts to solve a community health problem more effectively than either organization can working alone.

  • PALPATION BY BLIND EXAMINERS: A NOVEL APPROACH FOR GLAUCOMA SCREENING

  • This article focuses on risk factors for glaucoma. Although there are several risk factors for glaucoma, elevated intraocular pressure (IOP) remains the major risk factor. Palpation is one of the oldest, simplest, and least expensive methods for approximate IOP assessment. Researchers believe that blind individuals may possess a more acutely developed sense of touch, which has already proved to be beneficial in clinical breast examination to detect early breast cancer. Based on successful findings of a project that used blind and visually impaired individuals as breast examiners, we hypothesize that blind individuals may also serve as successful examiners for estimation of IOP using tactile palpation.

  • SCREENING FOR GLAUCOMA IN THE CHINESE ELDERLY POPULATION IN SINGAPORE

  • This article focuses the performance of different tests in screening for glaucoma. Optic nerve assessment performed better than other glaucoma screening tests.

  • DETECTION OF GLAUCOMATOUS VISUAL FIELD DEFECT USING A SCREENING PROGRAM OF HUMPHREY FIELD ANALYZER

  • This article focuses on Armaly central field screening test compared to central 30-2thereshold test of Humphrey field analyzer.

  • A MANUAL FOR ORGANIZING AND CONDUCTING A STUDENT SIGHT SAVERS PROGRAM

  • This is a manual on organizing and conducting glaucoma screening programme.

  • A NOVEL APPROACH TO GLAUCOMA SCREENING AND EDUCATION IN NEPAL

  • This article focuses on combination of clinical outreach programs and educational activities for patients.

  • "THE APPLICATION OF TELEOPHTHALMOLOGY IN EXAMINING PATIENTS WITH GLAUCOMA: A PILOT STUDY"

  • This article introduces a preliminary model for economic assessment of telemedicine application in ophthalmology A video slit-lamp, an automated perimeter, a nonmydriatic fundus camera and a videoconferencing system were installed in a healthcare center in a rural area. Twenty-nine patients with glaucoma were examined in the rural healthcare center instead of the university eye clinic. A control group consisted of 41 glaucoma patients examined at the eye clinic one year earlier. An ophthalmic resident examined the patients together with the local general practitioner. An interactive video consultation was created with the university glaucoma clinic using ISDN connections and special application software. The quality of the images obtained in the remote center was poorer than that of the images obtained at the university clinic. This study indicates that further research with a larger number of patients is warranted to evaluate both methods, technology, and economics of teleophthalmology.

  • EARLY DETECTION OF GLAUCOMATOUS VISUAL FIELD LOSS: WHY,WHAT, WHERE, AND HOW.

  • This article provides a basis for understanding modern visual field analysis techniques. It describes some of these tests, including their advantages and disadvantages, and the settings in which different tests might be used most successfully. It also includes an examination of the value of visual field assessment from a public health standpoint with particular attention paid to morbidity, cost/benefit ratios, and quality of life correlations.

  • SCREENING FOR GLAUCOMA IN THE CHINESE ELDERLY POPULATION IN SINGAPORE

  • This article aims to determine the performance of different tests in glaucoma screening in the aging population in Singapore and provides the suggestion to preventing method, public education and screening methods of glaucoma.



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The following articles clearly stated the benefits of glaucoma screening and also provided Medicares glaucoma screening benefits for early detection and treatment of this disease


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High intraocular pressure, aging, family history of glaucoma, race are the important risk factors of glaucoma, apart from that high Myopia , Diabetes, Hypertension, Eye Injury or Surgery are also possible risk factors of glaucoma.
  • GLAUCOMA CAUSES OPTIC NERVE CUPPING (ATROPHY) AND VISION LOSS

  • Aging eye net website provides the detailed information about risk factors of glaucoma, level of glaucoma risk based on risk factors, family history and gene etc. Glaucoma risk estimator (calculator) also provided for estimation of five year risk of Glaucoma.




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The following articles focus on the Importance of glaucoma Awareness.


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HISTORY OF GLAUCOMA
The term glaucoma goes back to Hippocratic times. When the term was accepted to signify greenish -- like the colour of sea water -- Hirschberg has shown that it is much more likely to mean bluish. It would appear that in Hippocratic writings hypochyma and glaucosis were synonyms, and both vaguely referred to cataract.

Absolute glaucoma is historically referred as "green cataract", Glaucoma, in antiquity, therefore hardly stood for any definite entity. But the term created a problem in pathology when Brisseau showed that cataract was a disorder of the lens itself. The first clear recognition of absolute glaucoma came with Rikchard Banister in 1622. Discussing the differential diagnosis between curable cataract and incurable gutta serena in which "the humour settled in the hollow nerves, be growne to any solid or hard substance, it is not possible to cured" Acute glaucoma, though not under that name, has a more considerable antiquity. The Arabian Sams-ad-din recognized it as a distinct entity in the amorphous mass of ophthalmias Sir William Lawrence considered glaucoma "to be merely a chronic form of the same inflammation as the arthritic inflammation affecting the posterior coats of the eye. He introduced the term, acute glaucoma in1829.

Acute glaucoma, in contra-distinction to chronic glaucoma, only emerged after 1830. Acute glaucoma, in contra-distinction to chronic glaucoma, only emerged after 1830, and that too must have been incurable, for only very severe attacks would be recognized as glaucoma and the treatment would not improve matters, for it consisted of the same as for other forms of iritis. Till 1857, when von Graefe introduced iridectomy for acute glaucoma, the diagnosis was indeed tantamount to a sentence of blindness, for even relief from miotic was unknown till about 1875. Surgical Iridectomy for acute glaucoma was thought and started by Von Graefe.

Reference:http://www.mrcophth.com/Historyofophthalmology/glaucoma.html


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Hans Goldmann

Hans Goldmann (1899-1991), born in Komotau in Bohemia, studied medicine in Prague. He was trained in physiology by A.V. Tchermak-Seysenegg and in ophthalmology by A. Elschnig in Prague and by A. Siegrist in Berne. He succeeded Siegrist as chairman of the Department of Ophthalmology in Berne in 1935. He was granted Swiss citizenship in 1936. For almost 70 years, Hans Goldmann has influenced, and continues to influence, the daily practice of ophthalmology. In 1933, he and W. Haag and H. Papritz produced the Haag-Streit-Slitlamp 320. This instrument, together with contact lenses that he developed, enabled the whole eye from the surface of the cornea to the fundus to be examined with the patient in the seated position. In 1945, the Goldmann Cupola-Perimeter followed, which allowed the standardization of background and target luminance. The applanation tonometer was introduced in 1954 and, in 1958, the Haag-Streit Slitlamp 900. The presentation of every new instrument was accompanied by a clinical article demonstrating its value. Goldmann's research culminated in the understanding of the production and outflow of the aqueous. He determined the volume of the anterior chamber in 1941, detected the aqueous veins in 1945, proved that these contain aqueous in 1949, measured aqueous production by fluorescein dilution curves in 1950, and coined the formula that determines outflow facility. He became known in particular for his exceptional and fundamental work on perimetry and glaucoma and he managed to cast his basic insight into practical, easy-to-operate, high-precision diagnostic instruments which, several decades after their invention, are still used by every ophthalmologist. He will enter history as one of the very great pioneers in ophthalmology.


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GLAUCOMA RESEARCH FOUNDATION

Glaucoma Research Foundation is the nations largest funder of innovative glaucoma research, outside of the National Eye Institute (NEI), academia, and internally-funded corporate research.

Founded in 1978 in San Francisco, the Glaucoma Research Foundation (GRF) was created to encourage innovative research to find better ways to care for people with glaucoma. This initiating idea has been the motivation for $48 million of grants and projects funded by GRF over the past 32 years. In addition to attracting innovative scientists, doctors and ideas to the field of glaucoma research, GRF provides education and support for those with glaucoma, their families and friends.

Our Mission
To prevent vision loss from glaucoma by investing in innovative research, education, and support with the ultimate goal of finding a cure.



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